What is the recommended enteral feeding dosage for a 75 kg patient?

Enteral Feeding Dosage for a 75 kg Patient

For a 75 kg patient requiring enteral nutrition, provide 1,000 mg/day of ribavirin-equivalent calories (approximately 1,500-2,000 kcal/day total energy) with 1.2-1.5 g/kg/day of protein (90-112.5 g/day), delivered via continuous pump feeding starting within 12-24 hours of admission. 1

Energy Requirements

• Target 35-40 kcal/kg/day (2,625-3,000 kcal/day for a 75 kg patient) in postoperative or critically ill patients 1
• For standard medical ICU patients, a minimum of 20 kcal/kg/day (1,500 kcal/day) should be achieved 2
• Energy delivery should cover 1.3x Resting Energy Expenditure, with glucose providing 50-60% of non-protein energy and lipids providing the remainder 3

Protein Requirements

• Deliver 1.2-1.5 g/kg/day of protein (90-112.5 g for a 75 kg patient) 1, 4
• This protein target applies across cirrhosis, liver transplant, and general critical illness populations 1
• In critically ill patients with obesity (BMI 30-40), consider up to 2 g/kg ideal body weight 1

Practical Implementation Protocol

Initiation Timeline

• Start enteral nutrition within 12-24 hours of ICU admission or postoperatively 1
• Do not delay for patients who cannot meet caloric requirements orally 1

Volume Progression

• Increase feeding volume daily by 500 ml 2
• Target maximum of 2,000 ml/day by day 4 of admission 2
• This standardized protocol achieves an 86.2% delivery-to-prescription rate 2

Route Selection

• Begin with gastric feeding via fine-bore nasogastric tube 5
• Check gastric residual volume every 4 hours if gastrointestinal motility is questionable 6
• If GRV exceeds 200 ml, review feeding policy and consider: 6
  • Reducing feeding rate
  • Adding prokinetic agents (metoclopramide or erythromycin)
  • Transitioning to post-pyloric (jejunal) feeding

Formula Selection

• Use standard whole protein formulae as first-line 1
• Consider concentrated high-energy formulae (>1.0 kcal/mL) in patients with ascites for fluid balance 1
• Switch to BCAA-enriched formulae only if hepatic encephalopathy develops during feeding 1

Micronutrient Supplementation

Essential Daily Additions

• Provide water-soluble vitamins and trace elements from day 1 of enteral nutrition 3
• Administer thiamine 100-300 mg/day IV for 3-4 days in ICU patients, particularly those with suspected malnutrition or alcohol use, before starting glucose-containing feeds 1, 7
• Standard enteral formulas at 1,500 kcal/day typically meet micronutrient needs, but patients receiving <1,500 kcal/day require additional supplementation 1

Monitoring Parameters

Clinical Assessment

• Position patient at 30° or more during feeding and for 30 minutes afterward to minimize aspiration risk 6
• Monitor for feeding intolerance signs: vomiting, abdominal distension, reflux into oral cavity 6
• Check blood glucose regularly to detect hypoglycemia and avoid hyperglycemia 3

Laboratory Monitoring

• Monitor phosphate, potassium, and magnesium levels to prevent refeeding syndrome, especially in malnourished patients 3
• Routine vitamin level monitoring is not recommended except for vitamin D 7

Critical Pitfalls to Avoid

Refeeding Syndrome Prevention

• In severely malnourished patients, start cautiously and monitor electrolytes closely 3
• Never administer glucose before thiamine in at-risk patients, as this precipitates Wernicke's encephalopathy 3

Common Feeding Errors

• Avoid interrupting feeds unnecessarily - EN interruptions occur in 32.1% of feeding days and significantly reduce caloric delivery 2
• Do not use PEG placement in cirrhotic patients due to higher complication risk; use nasogastric or nasojejunal tubes instead 1
• Enteral feeding can be safely administered even with esophageal varices present 1

Tolerance Issues

• Post-pyloric feeding becomes necessary in approximately 36% of patients due to high gastric residuals 2
• Delayed achievement of target feeding volume (>4 days) correlates with 73.3% mortality versus 26.1% in those reaching target by day 4 2

Alternative Approach: Permissive Underfeeding

• In select mechanically ventilated patients, permissive underfeeding (50% of daily energy expenditure, approximately 1,300-1,500 kcal/day for 75 kg patient) with maintained protein at 1.2-1.5 g/kg/day produces similar outcomes to full feeding 8
• This approach reduces insulin requirements and improves gastrointestinal tolerance 8
• However, standard full feeding remains the primary recommendation unless specific contraindications exist 1